상악결손부의 2차적 재건에 있어 유리 혈관화 피판의 적용
Late reconstruction of oncological maxillary defect with microvascular free flap
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초록
악성종양의 절제후 초래되는 복합 상악 결손(composite maxillary defect)은 상악의 경조직 결손뿐만 아니라 연조직까지 결손되는 경우를 의미하며, 주로 저작, 발음, 연하 등의 기능적 측면과 심미적인 측면에서도 환자들이 많은 어려움을 겪게 된다. 통상적으로 이러한 결손부가 초래된 경우 악안면보철물(maxillofacial prosthesis)을 통하여 어느 정도 기능적인 수복을 도모하게 되지만 보철물 역시 부피가 커서 환자들이 구강내 장착하고 빼내는 과정에서 많은 어려움을 가지게 된다. 상악골 결손으로 인한 안면부 외형의 연조직 결손이 동반될 경우, 악안면 보철만으로는 수복할 수 없는 경우도 있다. 특히 상악에 생긴 악성종양을 제거하고 난 후, 구강, 상악동, 치은, 나아가서는 관골, 안와하 부위의 결손부를 남기게 되므로 이 부위의 결손은 우선 안와하의 구조물을 지지하여야하고, 구강-상악동의 개통으로 인한 음식물 섭취시의 불편함을 최대한 방지할 수 있어야 하고, 가급적 안면부의 대칭성을 얻어 환자가 사회생활에 복귀할 수 있도록 해야 한다. 이러한 관점에서 악안면 보철물뿐만 아니라, 연조직 및 경조직의 수복을 위한 많은 방법이 소개되었다.
Abstract
Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functional aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flap is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemo-radiotherapy.
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